Renal function in pediatric liver transplantation: a long-term follow-up study.
BACKGROUND
Renal impairment is a frequent complication after orthotopic liver transplantation (OLT). However, most studies in children use inaccurate renal assessment based on serum creatinine, and long-term follow-up data are lacking. The purpose of this study was to determine incidence, determinants, and progression of long-term chronic renal insufficiency (CRI) in a single-center series of pediatric liver transplant recipients.


METHODS
The true glomerular filtration rate was measured by inulin clearance before and serially after OLT in 69 consecutive patients followed more than 2 years after transplantation. Cumulative incidence of CRI (glomerular filtration rate<60 mL/min/1.73 m2) was determined using a Kaplan-Meier method. A Cox proportional hazard model was performed to identify predictors of CRI.


RESULTS
The median age at OLT was 3.2 years. The median follow-up time after OLT was 9.3 years (interquartile range 6.3-11.9). At 10 years post-OLT, the cumulative incidence of CRI was 25%. In a multivariate Cox regression model, arterial hypertension during follow-up as time dependant variable (P=0.03), cyclosporine as primary immunosuppression (P=0.048), and liver diseases with potential renal involvement including inborn errors of metabolism, Alagille syndrome, and hepatic fibrosis (P=0.003) were associated with CRI.


CONCLUSIONS
Renal function is a major concern long after OLT in children. Renal dysfunction post-OLT may be reduced by optimal control of arterial hypertension, immunosuppression protocols adapted to primary liver disease, and calcineurin inhibitor sparing regimen.
Harambat
Jérôme
J
Service de Pédiatrie et centre de référence des Maladies Rénales Rares, Hospices Civils de Lyon et Université Claude-Bernard Lyon 1, Lyon, France.
Ranchin
Bruno
B
Dubourg
Laurence
L
Liutkus
Aurélia
A
Hadj-Haïssa
Aoumeur
A
Rivet
Christine
C
Boillot
Olivier
O
Lachaux
Alain
A
Cochat
Pierre
P
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D016572:Cyclosporine / Q000009:adverse effects; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D006973:Hypertension / Q000150:complications; D007166:Immunosuppressive Agents / Q000009:adverse effects; D015994:Incidence; D007223:Infant; D007444:Inulin; D053208:Kaplan-Meier Estimate; D008107:Liver Diseases / Q000150:complications; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D016016:Proportional Hazards Models; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D017741:Survivors; D013997:Time Factors
D007166:Immunosuppressive Agents; D016572:Cyclosporine; D007444:Inulin